Vol 28, No 2 (2024)

Background and objective: β-Thalassemia is a common inherited disease in this region. A considerable number of transfusion-dependent β-thalassemia (TDT) patients suffer bone problems. The objective of this study was to evaluate bone mineral density in TDT patients using dual-energy X-ray absorptiometry (DEXA) scan.

Methods: In this study, 53 TDT patients aged ≥10 years, together with 25 normal healthy individuals were enrolled. Their bone status was assessed using DEXA scan at lumber spine (L1-L4) and femoral neck. The effect of physical, biochemical, and hormonal characteristics on the bone mineral density (BMD) parameters were evaluated. BMD-Z score was used to assess the magnitude of bone disease.

Results: The mean age of the patients was 21.3±7.8 years with male to female ratio 1.4:1. The values BMD parameters were significantly lower in the patients compared to the normal group. The mean values of BMD Z-core among the patients at lumber spine and femoral neck were -2.95±1.07 and -1.51±1.02 respectively. Among the patients, osteoporosis was detected in 69.8% and 13.2% in lumber spine and femoral neck respectively. None of the normal individuals had osteoporosis. Patients’ age. body mass index (BMI) and parathyroid hormone level had a significant association with BMD Z-score (P <0.05).

Conclusion: Osteoporosis and osteopenia are extremely prevalent among our TDT patients. DEXA scan is an effective, non-invasive, and relatively inexpensive procedure for assessing bone status.

Background and objective: Acute leukemia (AL) patients are at high risk for bleeding and thrombotic events due to the disruption of the normal hemostatic system associated with this disease. As a result of the lack of data on coagulopathy in AL patients in our locality, we conducted this study to assess the hemostatic parameters in patients with newly diagnosed AL at the time of presentation.

Methods: This prospective cross-sectional study included 59 patients with de novo AL, along with 35healthy control subjects. The study was conducted at Nanakali Hemato-Oncology Center between September 2021 and May 2022. Coagulation markers, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen levels (FBG), D-dimer (D-Di), antithrombin (AT), protein C (PC), and protein S (PS) were measured for each patient and control.

Results: The median age of the patients was 41 years, with a male to female ratio of 1.1:1. Thirty-eight (64.4%) patients had acute myeloid leukemia (AML) and 21 (35.6%) patients had acute lymphoblastic leukemia (ALL). D-Dilevels were significantly raised in both AML and ALL compared to controls. PT was significantly higher, and PC and AT were significantly lower in AML compared to ALL or control groups. The Bleeding incidence in AML was significantly higher than in ALL (65.8% versus 23.8%). Thrombosis occurred in two (3.4%) patients.

Conclusion: Coagulation abnormalities were common in AL. The hemostatic derangement and bleeding at the time of presentation were more pronounced in patients with AML than in ALL.

Background and objective: Obstructed labor is a serious intrapartum emergency especially seen in women deprived of modern healthcare delivery. It could be one of the major reasons of morbidity and mortality for both the mother and the newborn. This study was aimed at determine the rate, causes and perinatal outcomes of women who have obstructive labor during delivery.

Methods: A cross-sectional study that was conducted on 150 delivering women having obstructed labor at Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq from 1^st of March 2021 to 1^st of March 2022 The rate, socio-demographic characters (age, parity, smoking, antenatal care, residency, education level, gestational age), causes like (malposition, malpresntation, cephalo-pelvic desorption) and perinatal outcomes were recorded.

Results: of 9137 labor, 150 were obstructed labor; the total rate was 1.6% during the period of the study. There was no statistically significant associated between socio-demographic characters like age, smoking, gestational age, residency, education level, antenatal care and obstructed labor except multiparity that has significant association. There was a significant association between the causes like cephalo-pelvic disproportion, malposition, malprsentation, sized baby and having fracture to spine and pelvis or trauma and obstructed labor. Also there was no statistically significant associated between Apgar score and admission to neonatal intensive care unit.

Conclusion: Obstructive labor is common during labor. Malposition was most common the cause of obstructive labor and parity has association with it too. Neonatal morbidity and mortality are dependent on the type of presentation.

Background and objective: Increased blood sugar levels (hyperglycemia) and lack of insulin are a hallmark of Type 1 diabetes mellitus (T1DM), which is a chronic autoimmune illness results from the destruction of pancreatic beta –cells. The most common causes of hypothyroidism and hyperthyroidism are autoimmune diseases Hashimoto's thyroiditis and Graves’ disease, respectively. Because type 1 diabetes includes autoimmunity as a pathophysiological trigger, it is not uncommon to investigate patients with both diabetes and thyroid problems. The aim of the study is to evaluate serum thyroid hormones in patients with type1 diabetes mellitus.

Methods: In this study 104 participants were included, 52 patients with type1 diabetes, and 52 healthy individuals. Blood samples were taken, and serum thyroid hormones levels were measured and the results of cases and controls were analyzed and compared using SPSS program.

Results: It was found that the levels of T4 among non- diabetic participants were higher than those of diabetic patients. (P <0.001). There is a negative correlation between BMI and fasting blood glucose in T1 diabetic patients according to regression test it has been shown that any increase in the FBG leads to decrease in the BMI.

Conclusion: The present study shows that type 1 diabetes mellitus may affect thyroid gland and thyroid hormone levels, that may result in thyroid dysfunction.

Background and objective: Salicylic acid (SA) has keratolytic activities and it is used topically to treat dandruff and seborrheic dermatitis. The hydrotropic phenomenon in pharmaceutical preparations is utilized to enhance the solubility of water-insoluble drug molecules that promoted to prepare the salicylic acid as a hair gel for local effect and it can extend its keratolytic action for a longer period compared to the salicylic acid solution.

Methods: Preformulation study was performed to exclude any unwanted chemical interaction between SA and excipients using Fourier-transform infrared spectroscopy (FTIR). The solubility of SA was determined separately in sodium acetate and sodium citrate solutions at a concentration of 1, 3, and 5 %w/v, using distilled water as a solvent. An optimum gel formulation was developed and it was used to prepare the SA gel formulation. Characterizations were performed in terms of physical appearance, viscosity, pH, and spreadability, in-vitro studies were performed in physiological pH, and ex-vivo diffusion studies were performed utilizing rats’ skin.

Results: FTIR did not show any chemical interaction between the drug and sodium citrate. The hydrotropic solution of sodium citrate with a concentration of 5% w/v increased the solubility of SA by 28 folds, while the sodium acetate solutions with a concentration of 5% w/v increased the solubility of SA by 19 folds. The optimum gel formula (F1) with a drug content of 97% showed a slow dissolution rate and minimum diffusion through the skin.

Conclusion: The hydrotropic solubilization technique significantly influenced the solubilization of salicylic acid in the water and the highest solubility rate was achieved from 5% w/v sodium citrate solution. The formulated hydrogels using carbopol 971P as gelling agent decreased the diffusion rate of SA.

Background and objective: Obesity is a worldwide epidemic and a public health concern. It is one of the most significant alterations occurring in the menopause. It is closely related to the development of endometrial bleeding, increase endometrial thickness and endometrial cancer. The main objectives of this study were to demonstrate the independent effects of obesity and its relationship with endometrial thickness and histopathological outcome in women experiencing vaginal bleeding after menopause.

Methods: The study included hundred women who were experiencing postmenopausal bleeding included in this study. Their obesity was calculated by BMI. Biopsy taken from them either through a Pipelle sampler as an outpatient, or hysteroscopy under general anesthesia, or with dilatation and curettage under general anesthesia for histopathology examination to decide endometrial thickness and related pathology.

Results: The mean age of the studied women was 57.2 ± 6.4 years, which ranged between48 – 83 years. The mean endometrial thickness (ET) of the whole sample was 10.64 mm. The highest was 13.36 mm among obese women with a BMI of ≥ 35 Kg/m². There was a significant correlation between BMI and endometrial thickness. endometrial polyps were detected in 50% women who had normal weight. The highest mean of ET (13.95 mm) was detected among women with endometrial carcinoma. There was no any significant relationship between age of menopause with the histopathological diagnosis. The highest rate of endometrial carcinoma was detected among obese women of ≥ 35 Kg/m².

Conclusion: According to the current study, obesity increases the risk of endometrial cancer and endometrial hyperplasia in postmenopausal women.

Background and objective: Staghorn stones are large branching stones that completely or partially occupy the renal pelvis and renal calyces. The developments in the urological field have decreased the role of open surgery (OS) and currently percutaneous nephrolithotomy (PCNL) is considered as the gold standard procedure for the management of staghorn stone. This study aimed to determine the outcomes of open surgery and percutaneous nephrolithotomy for the treatment of unilateral staghorn stone.

Methods: This retrospective analysis included 76 patients with unilateral staghorn stone who had been treated with either percutaneous nephrolithotomy (57) or open surgery (19). A comparison was made between the mentioned groups (PCNL vs. OS).

Results: The differences between the two groups were not significant in term of preoperative characteristics. In addition, there was no significant difference between the two groups for intraoperative, postoperative complications and the rate of stone clearance (P = 0.447, P = 0.180, P = 0.259 respectively). The means of postoperative hospital stay (days) and recovery time (weeks) were significantly lower in the PCNL than OS (P <0.001). However, the mean operative time was significantly less in the OS group (P = 0.018).

Conclusion: The PCNL is a very efficient treatment option for staghorn stones. However, the open surgery still has a role in the treatment of kidney stones (especially staghorn stone).

Background and objective: Poorly water-soluble dugs provide less dissolution rate and bioavailability; hence, it minimizes the pharmacological effect of orally administered medications. Gliclazide is a sulfonylurea antidiabetic medication of the second generation, used to treat type II diabetes mellitus. It belongs to the class II drugs of biopharmaceutic classification system, indicating that it has high permeability and poor aqueous solubility. The aim of this study is to determine an optimum solid dispersion method and drug to carrier ratio to improve the solubility of gliclazide.

Methods: Solid dispersions of gliclazide were formulated with polyvinyl pyrrolidone K30 using various drug to carrier ratios (1:1, 1:3, and 1:5) by utilizing kneading and solvent evaporation methods. Solubility and dissolution rate of solid dispersion formulas were compared with pure drug and co-ground mixtures. The formulations were further evaluated in terms of percentage of yield, drug content, FTIR, SEM, DSC, and XRD studies.

Results: The highest solubility improvement of gliclazide was obtained at the ratio 1:5 of gliclazide and PVP K30 utilizing solvent evaporation method, solubility increased about 2.54 folds (98.299 ± 5.77 µg/ml) as compared to pure gliclazide (38.739 µg/ml). Meanwhile, the greatest improvement in gliclazide dissolution rate was observed in the same solid dispersion formula that was about 105.76 % after 30 minutes. FTIR demonstrated no unwanted interaction between the drug and carrier. While, SEM, DSC, and XRD showed crystallinity of the drug was minimized and converted to amorphous form in solid dispersion formula.

Conclusion: Based on the investigations of this study, it can be concluded that the drug to carrier weight ratios and preparation methods had the influence on the drug solubility and the release rate. The obtained data revealed that the solvent evaporation is the best method of solid dispersion for enhancing gliclazide solubility using PVP K30 with the ratio 1:5 of the drug and carrier.

Background and objective: Fast dissolving tablets (FDTs) are "they are uncoated tablets that are supposed to be placed in the mouth and dispersed quickly before being swallowed" within minutes. This study aimed to formulate and evaluate a combination of ketorolac and rizatriptan as orally fast-dissolving tablets using the most common and easiest method to treat migraine attacks with or without aura. To investigate the effects of various types of diluents and super disintegrants on wetting time, water absorption ratio, disintegration, and dissolution time of combined drugs (ketorolac and rizatriptan) as oral dissolving tablets prepared by direct compression technique.

Methods: Pre-formulation experiments were carried out in order to rule out any physicochemical interactions between the two medications (ketorolac and rizatriptan) as well as between each drug and its excipients. Four different formulations of fast-dissolving tablets with different types and ratios of diluents and super disintegrants were created using the direct compression technique in order to improve the formulation. Organoleptic characteristics, weight variation, thickness, friability, hardness, disintegration duration, wetting duration, water absorption ratio, drug content, in-vitro dissolution, stability, and comparison tests have all been characterized. 

Results: According to FT-IR, the two drugs and excipients exhibit no physicochemical interactions. The ideal formula F4 contains crospovidone and Kyron T-134 at optimal concentrations of 2.5% and 2.5%, respectively, and provides the majority of pharmaceutical drugs to be released within the first five minutes, a strong stability profile, the shortest wetting time with the fastest disintegration time (10 sec), and a pleasant flavor (strawberry flavoring agent).

Conclusion: Kyron T-134 with Crospovidone in a (1:1) ratio provided rapid disintegration. Ketorolac tromethamine and rizatriptan benzoate may be made into fast-dissolving oral tablets using Kyron T-134 and Crospovidone. Improving migraine compliance is a reasonable goal.

Background and objective: polycystic ovarian syndrome (PCOS) is the most common female endocrine disorder during their reproductive age which results in hyperandrogenism and anovulation or oligo-ovulation. Significant changes occur in ovarian vascularization at the level of the intra ovarian arteries in PCOS patients. The objective is to assess Doppler hemodynamic changes in ovarian stromal arteries in follicular phase of the cycle in both ovaries in women with PCOS compared to normal ovulatory fertile women (control) using transvaginal Color Doppler technique, by calculating intra ovarian Doppler artery indices values: Resistive index (RI) and pulsatility index (PI) of both ovaries.

Methods: Two hundred women were included in the study. One hundred patients were diagnosed as PCOS (cases) according to Rotterdam’s criteria and another one hundred were normal fertile women (controls).

Transvaginal color Doppler technique is used in examining the recruited cases and controls, Doppler indices values of intraovarian stromal arteries were measured.

Results: in the current study, the RI and PI of the ovarian stromal artery were lower in women with PCOS (cases) compared to controls. These hemodynamic changes are a predictor for the diagnosis of PCOS.

Conclusion: Doppler ultrasonography was a successful tool in assessing the hemodynamic changes in PCOS women.

Background and objective: Syndactyly is among the most commonly treated hand anomalies by plastic surgeons. Since the 1800s,over 46 corrective procedures have been described. These techniques involve using different flap designs and full-thickness skin graft or depending on graftless techniques to achieve the goals. Some articles concluded that graftless techniques have shorter operative times and fewer postoperative complications.

The aim of the study is to evaluate the use of a local "hexagonal" dorsal advancement flap (HDAF) for syndactyly repair without using a skin graft.

Methods: Between March 2021 and March 2022, we operated on 18 subjects (25 web spaces) in Rizgary and Hawler teaching hospitals in Erbil. Our study subjects were children and adults with different types of syndactyly (congenital, recurrent, and post-burn). We studied the early outcomes of using HDAF and straight-line incision for syndactyly repair.

Results: The patients' ages ranged from 1.5 to 50 years, and the mean follow-up period was 6.3 months (1-13 months). The mean operation time was 98.5 minutes (40-160 minutes). Wounds were closed primarily without skin graft in 96% of the cases. We encountered neither a flap loss nor recurrences of syndactyly. The mean abduction angle achieved was 36.5º. All patients and their caregivers were satisfied with the aesthetic outcome.

Conclusion: Syndactyly repair using a hexagonal dorsal advancement flap and straight-line separation of the fingers is a safe and straightforward technique regardless of age and syndactyly class or type. It results in a relatively short procedure with good-looking and well-functioning fingers.

Background and objective: The World Health Organization advises against the use of the antiviral drug Remdesivir to treat severe COVID-19 infections due to potential toxicity. The molecular mechanism of this toxicity is not well established. ATP-binding cassette (ABC) transporters play an essential role in the transport of various drugs in many illnesses.

Objective: This study examines the possible role of ATP-binding cassette, subfamily D, member 3 (ABCD3) in Remdesivir toxicity.

Methods: Real-time PCR and MTT assays were used to demonstrate the toxicity of Remdesivir on ABCD3 gene expression in the HepG2 cell line. Enzyme-linked immunosorbent assay was used to detect serum ABCD3 levels, Prestige24i was used to detect C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) in the serum. Nano-Checker710 was used to detect D-dimer in the serum of the patients.

Results: Remdesivir exhibits dose-dependent toxicity to the HepG2 cell line. The drug toxicity is significantly increased at three doses of 5, 10, and 20 µg/ml in virus-free hepatic cell lines. It suppressed ABCD3 gene expression in both the HepG2 cell line and COVID-19 patients’ sera. COVID-19 virus increases serum levels of CRP, ALT, AST and D-dimer. The drug lowers serum CRP, transiently lowers D-dimer, and increases ALT and AST levels.

Conclusion: Remdesivir suppressed ABCD3 gene expression and increased levels of inflammatory markers. Remdesivir contributes to hepatocyte damage independently of the COVID-19 virus.

Background and objective: accurate estimation of gestational age is important for perfect antenatal care, as many pregnant women may don’t know their last menstrual period & not have a first-trimester ultrasound that is accurate in estimating the gestational age, and the routine fetal biometry in the second & third trimesters may be unreliable for some reason. Therefore, it’s necessary to develop an ultrasonographic parameter capable of reliably estimating gestational age at any point during pregnancy. This study aims to compare the accuracy of trans-cerebellar diameter (TCD) in n 2^nd and 3^rd trimesters for the calculation of estimated gestational age with the first-trimester crown rump length (CRL) which is the most accurate measurement for the estimation of gestational age.

Methods: This is a prospective study conducted in Erbil from the 1st of January 2021 to the 10^thof August 2022. A total sample of 258 antenatal women was included. The ultrasound examination was performed by a GE Voluson ultrasound system (GE health care 2015) machine using a 3.5 MHZ curved transducer. The CRL was taken between 6-13 weeks of gestational age, and TCD between 15-38 weeks. TCD is measured by keeping the calibers on the outer margin of the cerebellar hemisphere. Data were analyzed using the statistical package for social science SPSS V. 26.

Results: The mean transcerebral diameter during different gestational ages was 16.35 (±0.76) less than 18 weeks gestation, 21.48 (±1.7) between 18-25 weeks gestation, 28.03 (±1.79) between 25-32 weeks gestation, 35.52 (± 1.84) above 32 weeks gestation respectively. There is a statistically significant linear correlation between TCD and ECRL with (rho=0.992) (P <0.001)

Conclusion: The accuracy of the TCD in the second & third trimester of pregnancy is comparable with the estimated CRL in the first trimester, so this will help us in the estimation of the gestational age for pregnant women with unknown LMP and unavailable first-trimester dating scan.

Background and Objective: Surgical treatment is an effective option for symptomatic benign prostatic hyperplasia (BPH), after failed conservative therapy. Transurethral resection of the prostate (TURP) is considered as a standard treatment method for the management of the small to medium prostate while transvesical open prostatectomy (OP) is a standard option for great prostate. The objective of this study is to evaluate the efficacy and safety of both (B-TURP) and (OP).

Methods: The present study included 73 patients underwent either transvesical open prostatectomy (31 patients) or bipolar transurethral resection of the prostate (42 patients) between May 2019 to May 2021, in Erbil-city. The baseline characteristics, intraoperative and postoperative characteristics plus early and late adverse effects were obtained from medical records for all patients in both groups, retrospectively. The data analyzed and compared statistically.

Results: The baseline characteristics in the studied groups showed no significant differences except for the prostate size which was more on the OP group. According to the results, operative time was significantly (P <0.001) lower in the OP group. The means of the following variables in the OP group were significantly higher than those of the B-TURP group: Hospitalization days (P <0.001), days of catheter removal, back to normal activity (P <0.001), QoL score (P = 0.027), Qmax (P < 0.001), and PVR (P = 0.046), while no significant difference was detected regarding IPSS (P = 0.404).

Conclusion: B-TURP was superior to OP regarding the hospitalization days, recovery time back to normal day-activity, and quality of life. Otherwise, both mentioned approaches work well for the treating symptomatic BPH.

Background and objective: Obesity is a multifactorial disease. It is a multifactorial pathology that can be related to an altered nutritional behaviour or secondary to genetic, hypothalamic, iatrogenic or endocrine diseases. Obesity and visual acuity are negatively correlated, obesity may be linked to dysfunction of the mechanical and vascular components of the eye. The aim of the study is to find out the impact of obesity on eye health and the pattern of eye disease.

Methods: Across-sectional study was conducted in the Ophthalmology Department/ Erbil Teaching Hospital during the period from 1st of August 2021 to 31st of March 2022. A simple random sampling method was adopted, and a total of 300 participants with an age of more than 18 years old were enrolled.

Results: The percentage of cataract, glaucoma, age-related maculopathy, papilloedema, keratoconus, and retinal vein occlusion was higher in the case group than in the control group. Obesity is a significant risk factor for cataracts, age-related maculopathy, and papilloedema, while it was insignificant regarding keratoconus and retinal vein occlusion. The mean of internal ocular pressure and central corneal thickness was higher in the case group compared to the control group.

Conclusion: The prevalence of ocular disease was higher among the obese population than in those with normal weight. Obesity is a significant risk factor for ocular disease. Age and gender represented additional risk factors in some of the ocular diseases in obese people.

Background and objective: RAS gene mutations, including Harvey RAS, are a biomarker in studying many types of cancer, including colorectal cancer. Studying the molecular and mutations of the HRAS gene help in understanding the nature of the tumor and helps to formulate a suitable plan for prevention and treatment. The aim of the present study is to identify HRAS mutations among a sample of colorectal cancer.

Methods: The sample for the present study involved 20 Formalin fixed embedded tissue of colorectal carcinoma and 10 adjacent normal tissues were obtained from Rizgary Teaching Hospital in Erbil.

Results: The sample of the present study involved 20 patients (60% males and 40% females) with CRC. The mean age was 54.20 years, with an SD ±19.80. The study found a single HRAS mutation in the sample study. The size of the tumor mutated by HRAS is significantly different than other tumors (P = 0.009).

Conclusion: there was an HRAS mutation in a sample of colorectal cancers and the size of the tumor was different than other tumors in the study sample. Further studies needed about the mutation of the HRAS gene.

Background and objective: Fast-dissolving oral thin film (FDOF) is a novel and most advanced form of solid dosage form that dissolves or disintegrates in 1 minute when put in the mouth without water or chewing. Pre-gastric absorption of FODFs from the mouth, pharynx, and esophagus as saliva flows down into the stomach would improve the therapeutic benefit of the drug as oral films disintegrated in the mouth. The study is designed and purposed to use most water soluble, best type and concentration of polymers to be selected for use in combination to formulate melatonin oral thin films. Different types of synthetic water soluble polymers were utilized the preparation of films (hydroxypropyl methyl cellulose HPMC15M, sodium carboxy methyl cellulose NACMC).

Methods: Solvent casting method was performed for preparation of twelve placebo films at the beginning, to obtain and select suitable polymer type and concentration for use in combination to be formulated for drug loading. The films were evaluated for their characteristics like mechanical properties (thickness and folding endurance), surface pH and disintegration time. Percentage of release and assay of melatonin was taken. Comparison studies were performed on melatonin films from this study with melatonin oral disintegrating tablets release profiles. Best batch could be selected. Drug-excipient compatibility carried out as pre formulation study to see whether there is interaction between the drug and excipients used.

Results: Results from FT-IR showed no interaction between melatonin and polymers used, the prepared formulations were clear, transparent, non-sticky and easily removed from the plate surface with the thickness ranging from (0.04-0.07) mm depending on the polymer concentration. The times required for the films to disintegrate was ranging from 21-26 seconds, and the majority of melatonin was released within first 2 minutes within the dosage form.

Conclusion: Melatonin can be formulated as fast dissolving oral films using combination of water-soluble polymers by solvent casting method to obtain ease of administration without using water during administration, fast onset of action resulted from rapid disintegration.

Background and objective: Globally, tobacco use is one of the most serious public health concerns and preventable causes of morbidity and mortality, expected to reach annually more than 8 million deaths by the year 2030. In light of this estimation and limited surveillance of smoking, this study aimed to identify the tobacco use trends and patterns in various forms in Erbil city.

Methods: A community‐based cross‐sectional household survey was carried out from September 2021 through June 2022, on a sample of 2601 respondents selected through a multi‐stage cluster sampling method in Erbil city. A specially designed questionnaire through direct interviews was used to collect socio-demographic and smoking-related data.

Results: The prevalence of current daily smoking was 44.3%, occasional smoking was 14.5%, Ex-smoking was 8.0%, and those who never smoked before 33.2%.The prevalence of cigarette, and waterpipe smoking was 37.2%, and 46.5%respectively. More than half (51.0%) had tried to quit smoking at least once in their life, while 11.9% succeeded to quit. The main reason behind quitting was anticipated health risks (97.3%). The prevalence of smoking was significantly higher among those aged 20-29 years, single, males, college education, those having skilled manual /non-manual occupations, those who have smoker friends, and from a middle socioeconomic level

Conclusion: The prevalence of smoking (current daily and occasional) was more than half and about one-third never smoked before. More than half had tried to quit smoking at least once in their life but (11.9%) succeeded to quit due to anticipate health risks and family pressure.

Background and objective: Thoracic injuries are a common presentation in emergency hospitals in the Kurdistan region, mainly caused by road traffic accidents. Early and accurate diagnosis of rib fractures is essential in saving lives and preventing complications.

The objective was to assess the validity of ultrasound in the diagnosis of rib fractures in comparison to plain x-ray.

Methods: Present study was a cross-sectional study carried out in the Emergency department of Rozhalat Hospital in Erbil city-Kurdistan region/Iraq over ten months, from August 2021 to May 2022, on a sample of fifty-five (55) patients with suspected rib fractures. Rib fractures were diagnosed by the researcher based on clinical, ultrasound, and x-ray findings, and the findings of rib fracture were confirmed by CT-scan. All imaging methods were done at the Radiology department of Rozhalat hospital.

Results: The validity findings of ultrasound examination taking CT scan as the gold standard was as follow: (97.7% sensitivity, 63.6% specificity, and 90.0% accuracy), while the validity findings of x-ray examination taking CT scan as the gold standard were (56.8% sensitivity, 54.5% specificity and 56.3% accuracy). The validity of ultrasound in detecting cortical disruption or hematoma was (93.8% sensitivity, 43.6% specificity, and 58.1% accuracy), while the validity of CXR in the detection of displacement was (31.3% sensitivity, 84.6% specificity, and 48.7% accuracy).

Conclusion: Sonograph is an accurate diagnostic tool for detecting rib fracture with superior validity compared to a chest x-ray.

Background and objective: The size of the tumor significantly influences the prognosis and treatment approach for breast cancer patients. The aim of this study was to find the most accurate imaging method for estimating pre-treatment tumor size in women with newly diagnosed primary invasive breast cancer by comparing the predicted tumor size obtained from mammography, ultrasonography, and magnetic resonance imaging with the pathologic size obtained from the surgical specimens.

Methods: This cross-sectional study included 181 primary invasive breast cancer patients from September 2021 to March 2023. The difference in tumor size was evaluated based on imaging and pathological reports. Variables such as age, breast density, and tumor characteristics like histologic type, grade, location, and side were recorded and analyzed. The American College of Radiology Breast Imaging Reporting and Data System was used for reporting. Data analysis, performed using SPSS Statistics software, included descriptive statistics, Spearman's correlation coefficient, and Lin's index. The statistical significance level was set at P <0.05.

Results: The mean tumor size was 29.68, 29.07, 28.37, and 27.7mm by mammography, ultrasonography, magnetic resonance imaging, and pathology, respectively. All diagnostic procedures revealed a statistically significant correlation with pathologic tumor size with the Spearman correlation test, P = 0.000. MRI had the highest Lin’s concordance correlation coefficient (0.93).

Conclusion: The study determined that all imaging modalities were accurate in estimating tumor size when compared to the gold standard of pathological specimens and that magnetic resonance imaging outperformed digital mammography and ultrasonography.